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\\,JK SCIENCE~~~~~~~~-----~»-----------------IHOSPITAL NOTES'
Effective Leadeship for Better Management ofHospital
~omesh Gupta*, Jasbir Singh**
Introduction
The hospital is a complex organisation humm ing with
activities aimed to achieve the patient care satisfaction.
This organisation is, though, entirely different from other
organisations like cotton industry, industry associated
\\ ith production of toys or cars, yet all the principles of
management are applicable in the hospital environment.
Since hospitals are labour intensive organisations and
involve a large number of professionals who are working
in a "life and death activity", leadership is one of the
areas which attaches lot of significance in the hospital
management.
Definition
Leadership has been defined in various ways by
d iffcrent authors but the most appropriate one in the
hospital scenario is the process of influencing the
activities of an individual or a group so that they strive
will ingly towards the achievement of organisation goals.
Types of leadership
There are three types of leadership (Fig. 1).
1. Autocratic Leadership
The characteristics of Autocratic leadership are :-
(a) The leader mainly seeks the obedience from his
group. They have just to carry out the work as
desired by the leader.
(b) The entire authority is centralised with the leader
and he only determines everything.
(c) The leader structures complete work for his
employees.
(d) Communication IS usually unidirectional from
above downwards.
(e) Workers compliance is obtained through threats
and punishments. Those who obey orders are
rewarded and those who do not are punished. It is
a carrot and stick type of leadership.
(f) Employees have very little responsibility.
(g) Employees feel a certain amount of security.
(h) Decision making is quick and less competent
subordinates can be easily employed.
(i) Highly qualified professionals do not like this type
of leadership as there is lack of scope for growth,
development, initiative and sense of
responsibility.
*OCfluty J\ledical Superintendent, **Medical Superintendent, Government Medical College Hospital, Jammu (J&K) India.Correspondence to : Dr. Romesh Gupta, Deputy Medical Superintendent, Govt. Medical College Hospital, Jammu (J&K) India.
Vol. I o. 3. July-September 1999 134
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Fig. 1 : Types of leadership. L - Leader, E - Employee.
Epidemiology of Leadership ill different situations
(8 GL 000
CD f;\A0t~Democratic \V \V \VLeadership Free Rein Leadership
(8o
AutocraticLeadership
This is more suitable for research laboratories and similar
organ isations.
(a) Here the leader and workers share the decision
making.
(b) The leader draws the ideas and suggestions
from the workers by discussions and
consultations.
The characteristics of Democratic Leadership are :-
(j) Fear, conflict; dissatisfaction and frustration can
develop easily.
2. Participative or Democratic Leadership
(c) The workers are encouraged to take part In
setting organ isation goals and the job ofleader
is mainly that of moderation.
In order to determine the best leadership style
following three factors must be considered.
1. The situation in which the leading takes place.
(d) It is not a carrot arfd stick type of leadership.
There are no punishments but corrective
actions and rewards are based on objective
achievements.
(e) Commun ication is in all directions.
2. The people being led.
3.. The personal characteristics of the leader
himself. Because differences occur in all three of these
factors, there can be significant variation in leadership
styles, all of which are effective as shown in (Fig. 2).
OptimumLeaderhip
'/ Style ~
Situation .. .. Hospital Population
Leader(f) The workers have a sense of belonging and
satisfaction.
(g) Knowledgeable and skilled workers feel more
happy and satisfied.
(h) Decision making takes more time.
(i) Unskilled and lower level workers who have
strong need of security do not like this style.
Fig. No.2
1. Hospital population
3. Laissez-Faire or Free Rein Leadership
In this type of leadership, each worker has his own
authority and the leader is more or less like an
information booth. He exercises a minimum control and
assumes the role of just another member of the group.
[n the hospital there are various types of people, who
come across, like hospital employees, patients and the
visitors. But in this paper the scope is more or so limited
to the hospital employees. As already discussed hospital
is a complex organisation humming with various types
135 Vol. J No.3, July-September 1999
______________~JK SCIENCE
of activities performed by various groups of employees
ranging from unskilled to highly skilled and highly
qualified employees. Mainly the hospital employees can
be divided into three groups.
(a) Medical (Professionals).
their basic and security needs. Merel} l-;-;::;ney
and material benefits can satisfy this group.
Since their needs are very limited and require
job security, the autocratic style of leadership
is better way of controlling them.
(b) Nursing and paramedical.
(c) Non-medical.
(a) Professional employees: This group consists
ofdoctors, specialists and super specialists who
are highly qualified and highly skilled workers.
Although money and materials may motivate
some of them but basically they are motivated
only after their psychological needs are met
with. Their psychological needs can only be
met once they are participating actively in the
decision making. As a result ofwhich they feel
sense of belonging and achieve recognition as
well.
(b) Nursing and pa.-amedical employees: This
group consists of semiskilled, technical I
workers with social status lower than the
professional group. Initially they need job
structuring by autocratic way of leadership but
as the time passes, they acquire so much.proficiency that guidance and selfcontrol takes
higher precedence in motivating them and they
become an import'lnt constituent of the
democratic leadership.
(c) Non-Medical employees: This group consists
of ground level workers with very little
education and very low socio-economic status.
Their motivation comes through by meeting
Vol. I No.3, July-September 1999
2. Situation
There are two types of situations in hospital industry.
(a) Normal situation.
(b) Crisis situation.
(a) Normal situation: During normal situations
professional, nursing and paramedical groups
of workers are controlled better with the
democratic type of leadership. Even the
hospital disaster plan can be discussed and
modified accordingly as per the past
experiences with the group with democratic
type of leadership. The non-medical group of
employees are better governed by the autocratic
style of leadership even during the normal
situations.
(b) Crisis situation : The relatively sudden and
wide spread disturbance of the social system
and the life of a community by some agent or
event can amount to large scale admissions of
patients 'and lead to the crisis situation
in the hospital. Hospital disaster plan is
activated in such situations and the situation
demands autocratic style of leadership at that
time.
3. Leader
For achieving optimum leadership style the leader
136
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J'l(?:IK SCIENCE
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has to tailor his working according to the needs which
can be better understood in the following chart.
In olden days leadership was considered to be the in
born trait and used to run in the particular families. Due
to advancement of the scientific knowledge and with
availability of better management tools, now it is
considered that leadership basically involves motivating
the staff and application of communication skills.
Effective leadership is an essential requirement for higher
uti Iization ofscarce hospital resources and higher qual ity
Situation
Normal
Crisis
Summal'Y
Professional
employees.
Democraticstyle.
.Predominant
Autocraticstyle.
Nursing &
para-medicalemployees
PredominantAutocraticcoupled withDemocraticstyle.
Autocraticstyle.
Non-medical
employees.
Autocraticstyle.
Autocraticstyle.
of medical care. It has been discussed that democratic
style is more suitable for the normal situations among
the professional, nursing and paramedical group, whereas
crisis situations are better managed through autocratic
style of leadership. The non-medical group is better
controlled by the autocratic style of leadership. The
hospital administrator should have proficiency in all the
styles of leadership and should select the one according
to the situation.
References
I. Koontz HO. Donnel C and Weihrich H. Management. Me.Graw-Hill Kokakusha Ltd .. New Delhi. 1986: 505-24.
2. Harsey Pau!. Blanchard Kenneth H. Management of
organisational behaviour. Prentice-Ilall of India Pvt. Ltd ..
New Delhi. 1988 ; 105-26.
3. Massie, Joseph L. Essentials of management, Prentice-Hall
of India Pvt. Ltd., New Delhi. 1987 ; 98-111.
4. Newman WH, Warren EK. McGill AR. The process of
management, strategy, Action, Results Prentice-Hall of India
Pvt. Ltd., New Delhi. 1988 ; 350-69
5. McMahon Rosemary, Barton Elizabeth & Piot Maurice. On
being incharge. A guide for middle level management in
Primary Health Care. WHO Geneva 1980 ; 71-86.
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Local Correspondence:
Ajay K. GuptaBusiness Promotor
F-17, Shiv Nagar, behind A.G. Office, Jammu Tawi. Tele: 547174
137 Vol. 1 No.3, July-September 1999
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